Epidemiology and Health

Original Articles

Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents: Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae; Epidemiol Health. 2024;46:e2024028. Published online February 13, 2024; DOI: https://doi.org/10.4178/epih.e2024028

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure (EBP) in Korean adolescents, and that the association is dose dependent.
METHODS
This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were EBP and hypertension. Statistical analyses were conducted using SAS version 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.
RESULTS
A total of 2,518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean± standard deviation participant age was 15.3±1.7 years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2,090 (83.0%). Analysis of the 2,518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an odds of elevated blood pressure of 3.00 (95% confidence interval [CI], 1.14 to 7.89). The odds of hypertension were 3.61 (95% CI, 1.13 to 11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.
CONCLUSIONS
It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents’ blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.; Summary

Korean summary
청소년기의 고혈압은 성인기의 다양한 질병을 초래할 수 있는 주요 원인이다. 흡연과 고혈압의 관계에 관한 다수의 연구들이 있으나 상반된 결과들이 보고되었고 국내 청소년의 직 간접적 담배 연기 노출과 혈압과의 연관성은 명확하게 밝혀지지 않았다. 따라서 본 연구에서는 한국 청소년에서 담배 연기 노출과 혈압 상승과의 연관성을 확인해 보고자 하였다. 연구 결과 직접 흡연을 하는 청소년들은 비흡연군에 비하여 3배 이상 혈압이 증가하는 것으로 나타났다.

Key Message
Hypertension during adolescence is a leading cause of disease in adults. The relationship between smoking and hypertension has been studied, but findings between studies are conflicting. Nicotine is a known toxin, but the relationship between active and passive smoking and blood pressure in adolescents is not clear. So that we tested and found adolescents in Korea who were active smokers showed over 3-fold increased risk of elevated blood pressure.

Decreased birth weight after prenatal exposure to wildfires on the eastern coast of Korea in 2000: En-Joo Jung, Ah-Young Lim, Jong-Hun Kim; Epidemiol Health. 2023;45:e2023003. Published online December 9, 2022; DOI: https://doi.org/10.4178/epih.e2023003

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In April 2000, a series of wildfires occurred simultaneously in five adjacent small cities located on the eastern coast of Korea. These wildfires burned approximately 23,794 hectares of forestland over several days. We investigated the effects of prenatal exposure to the by-products generated by wildfire disasters on birth weight.

METHODS

Birth weight data were obtained for 1999-2001 from the birth registration database of the Korean National Statistical Office and matched with the zip code and exposed/unexposed pregnancy week for days of the wildfires. Generalized linear models were then used to assess the associations between birth weight and exposure to wildfires after adjusting for fetal sex, gestational age, parity, maternal age, maternal education, paternal education, and average exposed atmospheric temperature.

RESULTS

Compared with unexposed pregnancies before and after the wildfires, mean birth weight decreased by 41.4 g (95% confidence interval [CI], -72.4 to -10.4) after wildfire exposure during the first trimester, 23.2 g (95% CI, -59.3 to 13.0) for exposure during the second trimester, and 27.0 g (95% CI, -63.8 to 9.8) during the third trimester. In the adjusted model for infants exposed in utero during any trimester, the mean birth weight decreased by 32.5 g (95% CI, -53.2 to -11.7).

CONCLUSIONS

We observed a 1% reduction in birth weight after wildfire exposure. Thus, exposure to by-products generated during a wildfire disaster during pregnancy may slow fetal growth and cause developmental delays.

Summary

Korean summary
산불로 인한 연소 부산물에 대한 태아기 노출이 출생 체중에 미치는 영향을 조사하였다. 산불 발생 전후로 연소 부산물에 노출되지 않았던 신생아와 비교하였을 때, 노출된 신생아의 평균 출생 체중은 32.5g (-53.2~-11.7g) 감소하였다. 임신 중 산불로 인한 연소 부산물에 대한 노출은 태아 성장을 느리게 하거나 발달 지연을 일으킬 수 있다.

Key Message
The study investigated the effects of prenatal exposure to by-products generated by wildfire disasters on birth weight. Compared to newborns who were not prenatally exposed to wildfire byproducts, exposed newborns had a 32.5 g (-53.2 to -11.7 g) reduction in birth weight. Exposure to wildfire by-products during pregnancy can slow fetal growth or cause developmental delays.

Citations

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Natural Disaster Epidemiology and Reproductive Health
Emily W. Harville, Bianka Northland
Current Epidemiology Reports.2023; 10(4): 169. CrossRef

Perspective

Health effects of exposure to radon: implications of the radon bed mattress incident in Korea: Songwon Seo, Wi-Ho Ha, Jin-Kyu Kang, Dalnim Lee, Soojin Park, Tae-Eun Kwon, Young Woo Jin; Epidemiol Health. 2019;41:e2019004. Published online February 12, 2019; DOI: https://doi.org/10.4178/epih.e2019004

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Abstract

Radon is a naturally occurring radioactive material formed by the slow decay of uranium and thorium found in the earth’s crust or construction materials. Internal exposure to radon accounts for about half of the natural background radiation dose to which humans are exposed annually. Radon is a carcinogen and is the second leading cause of lung cancer following smoking. An association between radon and lung cancer has been consistently reported in epidemiological studies on mine workers and the general population with indoor radon exposure. However, associations have not been clearly established between radon and other diseases, such as leukemia and thyroid cancer. Radiation doses are assessed by applying specific dose conversion coefficients according to the source (e.g., radon or thoron) and form of exposure (e.g., internal or external). However, regardless of the source or form of exposure, the effects of a given estimated dose on human health are identical, assuming that individuals have the same sensitivity to radiation. Recently, radiation exceeding the annual dose limit of the general population (1 mSv/yr) was detected in bed mattresses produced by D company due to the use of a monazite-based anion powder containing uranium and thorium. This has sparked concerns about the health hazards for mattress users caused by radiation exposure. In light of this event, this study presents scientific information about the assessment of radon and thoron exposure and its human implications for human health, which have emerged as a recent topic of interest and debate in society.

Summary

Korean summary
라돈은 세계보건기구에서 지정한 발암물질로, 흡연 다음으로 폐암을 유발한다. 지난 2018년 5월에 D사 침대 매트리스에서 라돈 및 토론에 의한 일반인의 선량한도 기준치(1 mSv/yr) 이상의 방사선이 검출되었다. 이로 인해 침대 사용자의 방사선 피폭으로 인한 건강영향 우려가 대두되고 있다. 이번 연구에서는 라돈 침대 노출 사고와 관련하여 그 동안 잘 알려지지 않은 라돈 및 토론의 노출평가 및 역학 연구 결과들을 살펴보고, 그 시사점을 고찰한다.

Citations

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Fatemeh Rezaie, Mahdi Panahi, Sayed M. Bateni, Seonhong Kim, Jongchun Lee, Jungsub Lee, Juhee Yoo, Hyesu Kim, Sung Won Kim, Saro Lee
Environment International.2023; 171: 107724. CrossRef
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Hyun Su Lee, Sanghoon Hwang, Byoung-Chul Kim, Jong-Man Lee, Kyoung Beom Lee
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Sani Dimitroulopoulou, Marzenna R. Dudzińska, Lars Gunnarsen, Linda Hägerhed, Henna Maula, Raja Singh, Oluyemi Toyinbo, Ulla Haverinen-Shaughnessy
Environment International.2023; 178: 108127. CrossRef
SPATIAL DISTRIBUTION ANALYSIS AND DOSE ASSESSMENT OF THE RADON EMITTED FROM THE MONAZITE-CONTAINING MATTRESS IN GENERAL RESIDENTIAL SPACE BY CFD METHODS
Choong Wie Lee, Hee Reyoung Kim
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Tilak Nayak, Sohom Basak, Argha Deb, Paltu Kumar Dhal
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I. Gutiérrez-Álvarez, J.L. Guerrero, J.E. Martín, J.A. Adame, A. Vargas, J.P. Bolívar
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Lung cancer in never smokers: The role of different risk factors other than tobacco smoking
Luis Corrales, Rafael Rosell, Andrés F. Cardona, Claudio Martín, Zyanya Lucia Zatarain-Barrón, Oscar Arrieta
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Editorial

Lessons from radiation epidemiology: Won Jin Lee; Epidemiol Health. 2018;40:e2018057. Published online November 14, 2018; DOI: https://doi.org/10.4178/epih.e2018057

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Abstract Summary PDF Supplementary Material

Abstract

Radiation epidemiology has developed as a specialized field and has unique characteristics compared to the other fields of epidemiology. Radiation exposure assessment is highly quantified and health risk assessment can yield precise risks per unit dose in each organ. At the same time, radiation epidemiology also emphasizes the uncertainty of the estimated doses and risks. More radiation epidemiologists work in radiation societies rather than those of epidemiology. This specialization deepens the research of radiation studies but also results in fragmentation from general epidemiology. In addition to continued involvement with radiation-related sciences, therefore, more efforts to communicate with the other fields of epidemiology are necessary for radiation epidemiology.

Summary

Korean summary
방사선 역학은 역학의 세부 전공분야로서 다른 역학 분야와 구별되는 특성들이 있다. 노출 및 건강영향 평가에서의 정량화된 접근방법을 비롯하여 방사선 역학의 많은 장점들은 다른 역학분야에서도 응용될 필요가 있다. 이러한 전문화는 역학 연구의 내용을 깊게 발전시키는데 큰 역할을 하고 있는 반면, 일반 역학 분야와 분열되는 단점도 있다. 따라서 기존 방사선 관련 학문들과의 지속적인 교류뿐 아니라 다른 역학분야와의 활발한 교류를 통해 방사선 역학 및 전체 역학분야를 발전시키는 것이 중요하다.

Citations

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On the use of free code tools to simulate the propagation of radiation following dirty bomb explosions in sensible contexts
Riccardo Quaranta, Gian Marco Ludovici, Guglielmo Manenti, Pasqualino Gaudio, Andrea Malizia, A. Lyoussi, F. D’Errico, M. Carette, M. Joyce, R. Hodák, I. Jenčič, P. Le Dû, M. Morichi, S. Pospíšil, C. Reynard-Carette, L. Snoj, L. Vermeeren
EPJ Web of Conferences.2023; 288: 06009. CrossRef
The expression profile of redox genes in human monocytes exposed in vitro to γ radiation
Gina Manda, Cristian Postolache, Ionela Victoria Neagoe, Andreea Csolti, Elena Milanesi, Maria Dobre
Radiation Physics and Chemistry.2020; 170: 108634. CrossRef

Original Articles

Physician’s awareness of lung cancer screening and its related medical radiation exposure in Korea: Seri Hong, Suyeon Kim, Mina Suh, Boyoung Park, Kui Son Choi, Jae Kwan Jun; Epidemiol Health. 2018;40:e2018002. Published online January 20, 2018; DOI: https://doi.org/10.4178/epih.e2018002

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Abstract

OBJECTIVES
Through a survey on perception of lung cancer screening and accompanying medical radiation exposure in Korea, the present study was to investigate its current situations and evaluate various perception of physicians regarding it in order to propose measures for improvements.

METHODS

Medical specialists in national cancer screening institutions selected through stratified random sampling were subjected to face-to-face interview using a structured questionnaire. We investigated physicians’ perception on effectiveness of lung cancer screening depending on screening modality, selection criteria for subjects of screening, types of equipment used to screen, and perception for seriousness of adverse effects following the test. In addition, odds ratios to underestimate risk of radiation exposure from screening were calculated through logistic regression analysis.

RESULTS

Each response that chest X-ray is effective for lung cancer screening and that smoking history is not considered prior to screening recommendation accounted for more than 60% of respondents, suggesting the chance of unnecessary screening tests. Regarding adverse effects of lung cancer screening, about 85% of respondents replied that false positive, radiation exposure, and overdiagnosis could be ignored. About 70% of respondents underestimated radiation dose from lung cancer screening, and a low proportion of physicians informed patients of radiation exposure risk.

CONCLUSIONS

It was found that most physicians underestimated harms of lung cancer screening including radiation exposure and were lack of awareness regarding lung cancer screening. It should be noted that physicians need to have proper perceptions about screening recommendation and accompanying possible harms, for successful implementation of the screening program.

Summary

Korean summary
전국 100여개 국가암검진 기관을 대상으로 폐암검진 관련 설문을 수행한 결과, 효과적인 폐암검진의 수단이나 방법에 대한 이해 및 검사에 수반되는 각종 부작용에 대한 의사들의 인식이 확연히 부족한 것으로 조사되었다. 그 중에서도 특히 의료방사선 노출에 대한 낮은 인지도는, 촬영 시 피폭량에 대한 전반적인 과소평가 및 방사선 노출 위험과 관련한 환자 교육의 부재를 통해 확인할 수 있었다. 인구집단 대상 선별검사의 도입에 따른 잠재적인 위해 가능성과 그 결과에 대한 고민은 반드시 필요하며, 이와 관련된 의료제공자들의 인식 개선을 촉구하는 본 연구는 정책 도입에 앞서 선결되어야 할 과제로서 공중보건학적 측면에서 중요한 의의를 지닌다.

Citations

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Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption
Charlotte Poon, Tim Wilsdon, Iqra Sarwar, Alexander Roediger, Megan Yuan
Frontiers in Public Health.2023;[Epub] CrossRef
Why clinicians overtest: development of a thematic framework
Justin H. Lam, Kristen Pickles, Fiona F. Stanaway, Katy J. L. Bell
BMC Health Services Research.2020;[Epub] CrossRef

Occupation and mesothelioma in Sweden: updated incidence in men and women in the 27 years after the asbestos ban: Nils Plato, Jan Ivar Martinsen, Pär Sparén, Gunnar Hillerdal, Elisabete Weiderpass; Epidemiol Health. 2016;38:e2016039. Published online September 20, 2016; DOI: https://doi.org/10.4178/epih.e2016039

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Abstract PDF

Abstract

OBJECTIVES
We updated the Swedish component of the Nordic Occupational Cancer (NOCCA) Study through 2009 in order to investigate the incidence of mesothelioma of the peritoneum and pleura in both genders, and explored occupational exposures that may be associated with mesothelioma.

METHODS

The Swedish component of the NOCCA Study includes 6.78 million individuals. Data from this cohort were linked to the population-based Swedish Cancer Registry and Swedish Total Population Registry for three periods between 1961 and 2009, and then further linked to the Swedish NOCCA job-exposure matrix, which includes 25 carcinogenic substances and the corresponding exposure levels for 280 occupations. Multivariate analysis was used to calculate standardized incidence ratios (SIRs) for mesothelioma of the peritoneum and pleura by gender, occupational category, carcinogenic substance, and for multiple occupational exposures simultaneously.

RESULTS

A total of 3,716 incident mesotheliomas were recorded (21.1% in women). We found a significantly increased risk of mesothelioma in 24 occupations, as well as clear differences between the genders. Among men, increased risks of mesothelioma of the pleura were observed in male-dominated occupations, with the greatest elevation of risk among plumbers (SIR, 4.99; 95% confidence interval, 4.20 to 5.90). Among women, increased risks were observed in sewing workers, canning workers, packers, cleaners, and postal workers. In multivariate analysis controlling for multiple occupational exposures, significant associations were only observed between asbestos exposure and mesothelioma.

CONCLUSIONS

Asbestos exposure was associated with mesothelioma incidence in our study. The asbestos ban of 1982 has yet to show any clear effect on the occurrence of mesothelioma in this cohort. Among women, the occupations of canning workers and cleaners showed increased risks of mesothelioma of the pleura without evidence of asbestos exposure.

Summary

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Correlation Study on Clinical Laboratory Findings with Occupational Exposure to Low Dose Ionizing Radiation in Nuclear Workers in Korea.: Young Khi Lim, Keun Young Yoo; Korean J Epidemiol. 2001;23(2):8-18.

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Abstract PDF: Abstract
PURPOSE
Even though atomic energy and radioisotope had been made for a peaceful purpose, some of the public do't feel safe possibly due to potential exposure to ionizing radiation. While health effects of high level radiation are almost deterministic, the stochastic effects of the 'low-dose radiation' have not come to a correct conclusion. This correlation study was conducted to assess the health effect due to potential exposure th low-dose radiation in the nuclear power plants workers in Korea.
METHODS
The study subjects was selected among the nuclear workers. Among those who attend the epidemiologic survey for screening of any malignancies done by the study group of Seoul National University Hospital during 1992-1993, 1) those who had undertaken both the physical examination with clinical laboratory tests and the direct interview with questionnaire, 2) male workers, and 3) those with record on radiation dosimetry as well as employment records in the company. Correlation analysis with Pearson's correlation coefficients and quantitative analysis with normal ranges of various tests were done by the PC-SAS for window.
RESULTS
Total cumulative radiation doses was relatively low, ranging 1 mSv at the lowest to 391 mSv at the highest. Moreover, mostly 68.7% of the subjects was within lower limit of total cumulative doses under 10 mSv. Among the clinical laboratory test, statistical significant correlation was see in hemoglobin(HGB), creatinine(CRE), and carcinoembryonic antigen(CEA).
CONCLUSION
This study concluded that health effect of occupational exposure to low-dose ionizing radiation is minimal or, if any, extremely lower than expected in the nuclear power plants workers in Korea. Major limitation of this study is that the healthy worker effect could not excluded. A large-scale prospective epidemiologic study on the relationship between radiation exposure and health hazard is needed to draw a more valid conclusion.; Summary

A Review Study on Confounding Effect: Case-control Study.: Seonwoo Kim, Minji Kim, Soon Young Lee; Korean J Epidemiol. 1999;21(2):248-253.

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Abstract PDF: Abstract
Confounding is the distortion of a disease/exposure association brought about by other factors which are not considered in the study design or the data analysis. These factors are called confounding factors. We should be cautious in data analysis of observational study of association of disease/exposure, since confounding often occurred in observational study. This study examines confounding effect according to data pattern (the ratio of controls to cases, the ratio of exposures to non-exposures for each level of confounding factor), criteria for treating a variable as a confounding variable, and some notes for the analysis in case-control study.; Summary

Development of Lipoma among Residents Exposed to Glass Fiber Waste.: Hyun Sul Lim, Hae Kwan Cheong, Ji Yong Kim, Jung Ran Kim, Kiyoshi Sakai, Naomi Hisanaga; Korean J Epidemiol. 1999;21(2):159-175.

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Abstract PDF: Abstract
This study was conducted to determine the relationship between exposure to glass fiber waste from an insulator factory and the development of cluster of lipomas among local residents in suburb Incheon, Korea. Authors surveyed 152 residents(71 males and 81 females) living near an insulator factory with a questionnaire and physical examination. Unused and disposed fiberglass from the waste site, along with ground water samples were examined under light and polarizing microscope and scanning electron microscope(SEM). Subcutaneous tumors excised from three of the residents were also examined under light and polarizing microscope, SEM with energy dispersive X-ray analysis(EDX), and transmission electron microscope(TEM). Analysis of elemental composition of the fibers and fiber concentration was done by with EDX under SEM and TEM after low temperature ashing. Twelve(7.9%) had subcutaneous tumors among the 152 residents. Tumors were surgically excised from 3 of them and they were all lipomas, consisting of mature fat tissue. These lipomas contained abundant birefringent fibers and particles under polarizing microscope. The concentrations of the fibers were 6.7, 71.8 and 499.2 million fibers per gram dry tissue, respectively. The birefringent fibers were composed of needle shaped particles with rectangular fractured ends up to 17 micrometer in length and 0.5 micrometer in diameter. EDX and x-ray diffraction analysis of the fibers showed that 71 to 100% of the fibers were magnesium silicate, talc. Magnesium silicate fibers were also found in the glass fiber sampled from the waste site. Glass fibers and magnesium silicate fibers were also identified in the ground water. Based on the fact that the magnesium silicate fibers found in the lipomas were similar in morphology and elemental composition to those found in the ground water and those from the waste site, these particles are likely to be introduced into the gastrointestinal tract through consumption of the contaminated ground water. It is suggested that fibrous magnesium silicate, talc, a component of fiberglass waste, may be associated with the development of lipomas.; Summary

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